‘Well-being’ as a focus for public health? A critique and defence

Abstract

The concept of well-being has long attracted attention from multiple academic disciplines and interest has now spilled over into public and political domains in the UK. Yet a number of critical arguments might be made in relation to its utility for public health. For example, subjective well-being is broad and ill-defined, and is associated with contestable, morally laden ideas about happiness and ‘the good life’. Well-being has highly individualistic connotations and buys uncritically into the consumer culture of Western economies. The focus on well-being reinforces personal responsibility whilst intensifying the penetration of the individual's lifeworld by a range of experts or therapies. As a concern of the worried well of wealthy nations, well-being could exacerbate existing inequalities. Well-being may thus present a distraction from efforts to address enduring structural inequalities in health. Nevertheless, arguments can be made in its defence, not least the burgeoning science on the topic, and the suggestion that well-being may be an appropriate measure of what people value in life, and therefore relevant to public health. In this paper, we present a synthesis of favourable and critical perspectives on the topic. This provides the foundation for a critique of the diagnoses and prescriptions found in both positions. More broadly, we highlight doubts about the sustainability of the current, modernist paradigm which has failed to substantially reduce health or other inequalities yet to which contemporary public health efforts apparently remain tied. We suggest that a re-think in public health policy and practice may be required.